Updates to the Discovery CGM Benefit

Discovery Health recently sent out two emails about an update to the Discovery CGM Benefit. Here’s a simple explanation of what they mean.

Who the Discovery CGM Benefit is for

Let’s start with the bad news. This is specifically a benefit for people with Type 1 diabetes. Worldwide, CGM benefits always begin with Type 1s, and then move to Type 2s.

SA Diabetes Advocacy tried hard to get Keycare included this year, but Discovery said that because it’s on such a different pricing model to the other plans, it would be difficult to get the Scheme to agree. They were right, and the request was denied. We will keep trying!

The good news

The benefit has been improved!

• All children with Type 1 diabetes (excluding Keycare) now get two FreeStyle Libre sensors for free a month, or R1,560 towards another CGM.
• Adults on the top two tiers (Comprehensive and Executive) now get two FreeStyle Libre sensors for free a month, or R1,560 towards another CGM.

Requirements to begin the Discovery CGM Benefit

There are still two requirements to start the CGM Benefit, namely:

1. You need a once-off prescription
   From your specialist physician, endocrinologist, paediatrician or healthcare provider on the Premier Plus Network.
2. You need to be registered on the Chronic Illness Benefit (CIB) for Type 1 diabetes
   This is what ensures you get all your diabetes medication, so you’re probably already registered!

Understanding the lingo

Although we talk about ‘time in range’ (TIR) or ‘time in target’ a fair amount, there are two new terms that have been introduced now:

• TBR (time below range) for when your blood glucose is below the range set by your doctor (the pre-set number is 3.9mmol/l but you may change this).
• TAR (time above range) for when your blood glucose is above the range set by your doctor (the pre-set number for this is 10mmol/l but you may change it).

Read more about time in range and why it’s important, and find out how to set SMART time in range goals.

Get ongoing authorisation for the Discovery CGM Benefit

For the first time this year, Discovery have set time in range targets for continued authorisation for this benefit. This is a motivator to use CGM or flash glucose monitoring properly (some people claim the sensors and then don’t use them). It’s also so that they can gather data to show that CGM is definitively better than fingerstick blood glucose testing. (More on that below!)

If you want to get ongoing authorisation for the Discovery CGM Benefit, the targets are:

1. A TIR (time in range) of 60% or more over 6 months OR
2. A 10% improvement in your TIR over 6 months.

Remember! The 10% improvement in TIR (time in range) is from the baseline:

40% to 44% is a 10% improvement
50% to 55% is a 10% improvement

These targets are not intended as judgement. (Here’s a reminder of how to reframe your highs and lows). They have been created by endocrinologists (diabetes specialists) because they are in line with best practices for diabetes management – aiming for 70% TIR.

What happens if you don’t meet the targets?

If you have a sustained six months of not being able to meet the 10% improvement target, the CGM Benefit will be paused for you. This doesn’t mean you don’t ever get it back again – once you can show a 10% improvement, the CGM Benefit will activate again.

Remember: 10% improvement is off the baseline, so 40% to 44% is a 10% improvement. They are looking at the average over 6 months.

For the first 6 month target, they will compare month 1 with month 6. Thereafter, they will compare the previous 6 months to the current 6 months.

Discovery is also using this as a way to highlight those who need extra support with their diabetes management. Their goal is the same as yours: a long, healthy life with diabetes, supported along the way.

What exactly you have to do for ongoing authorisation

1. You need to create an account where your results are uploaded from your CGM or flash glucose monitor – if you haven’t already. FreeStyle Libre users will create this on LibreView, Dexcom on Clarity, Medtronic on Carelink.
2. Consent to share this sensor data with your doctor.
3. Twice a year, you have to interact with your doctor – either in person, or virtually. At this time, you have to ask your doctor to download a 6 month report of your TIR (time in range) from the platform you use.
4. Your doctor must then send this report to CIB_APP_FORMS@discovery.co.za
5. Alternatively, if you’ve signed up for LibreCoach – Abbott’s free diabetes support for anyone using the FreeStyle Libre – your coach can send the report to your doctor, easy peasy.

Please note!
LibreView offers 90 day (max) reports. So to get a 6 month report, your doctor will have to change the ‘report end date’ to 3 months ago and download that report. Then change the ‘report end date’ to today, and download a second report. These two 3 month reports make up the 6 month report.

Or just sign up for LibreCoach and get your coach to send it for you!

What is Discovery doing with your data?

This was my big question! I didn’t like the idea of someone looking at every blood glucose reading I’d had over the past 6 months. The answer is simple. When the report is sent in, one of Discovery’s pharmacists will look at it to check that you either meet the 60% TIR or the 10% improvement target. If you do, they authorise the CGM Benefit for you.

After that, the report goes through 3 layers of anonymity – which means they strip it of any identifying details so that they can’t link it to you. This anonymised clinical data is locked in Discovery Health – it’s not available to other sections of Discovery (Discovery Insure, Discovery Bank etc).

The anonymised data is used to assess whether or not CGM is better than fingersticks for people with Type 1 diabetes. They’ll look at things like hypo rates and claims history vs. no claims history. The goal is to show that it’s possible to react quicker with a CGM and as a result stay out of emergency rooms. Results like this will act as evidence: this is how Discovery can offset the costs of CGM, by showing that it does actually save them money.

Self-management is a saving for Discovery: not interacting with any healthcare services saves them money which they can then use to fund CGM further (yes please!)

Options on the Discovery CGM Benefit

There are currently three options for CGM or flash glucose monitoring in South Africa:

1. Dexcom G6
2. Abbott FreeStyle Libre
3. Medtronic Guardian or Enlite

You can read more about all three here: Your options on the Discovery CGM Benefit.

Do you have questions?

Reach out to your sensor provider for any other questions – they are there to help!

• FreeStyle Libre: DiabetesCareSouthAfrica@abbott.com
• Dexcom: info@ethitech.co.za
• Medtronic: rs.zadiabetesproductsupport@medtronic.com

Read more about the Discovery CGM Benefit

You can download the Benefit Guide from Discovery, below.

What to read next?

What is a CGM? Flash glucose monitoring and CGM: Not sure what the difference is, or what these words mean? Read this article.

We did it! How to claim the Discovery CGM Benefit: A step-by-step guide to claiming the new CGM Benefit.

Your options on the Discovery CGM Benefit: There are 3 CGM / flash glucose monitors available in South Africa. Here’s what they are, and how much they cost.

Photos by AllGo and Surface on Unsplash